Sleep health for all : Improving sleep for neurodiverse people
For all of us good sleep can too often feel a struggle, but recent science is shining a light that if you are neurodivergent, regular great sleep can be more of a nightly challenge.
With one-in-seven of the UK’s population thought to be neurodiverse, restless nights may be more common than you think.
While it’s comforting to know that you’re not on your own, our resident sleep and wellbeing expert (and neurodivergent herself ) Natalie Pennicotte-Collier knows the struggle only too well: “If you’re neurodivergent like me , you’ve likely struggled to fall asleep, stay asleep and wake up feeling rested. I understand and have experienced this myself, but there are ways to help you manage sleep better and it starts with understanding your own personal sleep and relaxation preferences.”
Circadian Sleep science spotlight
Research has highlighted that there’s a large overlap between neurodiverse conditions such as Autism and ADHD and difficulties with sleep. In fact, over 75% of neurodivergent people experience sleep struggles. Over time, this can trigger anxiety, increase stress and in extreme cases, impair function. Life can feel like a cycle of sleep deficit and fatigue for neurodivergent people, who often find it difficult to fall or stay asleep.
It’s also true that neurodivergent people frequently feel more alert in the evening, with theories for this including unique structural differences or chemical production. Some researchers have also suggested that the unique brain structures of neurodivergent people may change how they sleep. Aside from Insomnia, the symptoms most commonly associated with problems I help resolve include restlessness and hyperfocus, time blindness and struggles relaxing the mind and body.
These interruptions hint at an imbalanced circadian rhythm – the way cells stay in-sync with the day-to-night cycle. Add in sensory sensitivities to light, sound and touch; and it’s clear to see why many neurodivergent people have trouble getting a good night’s sleep.
A DIFFERENT SLEEP EXPERIENCE
Amongst the neurodiverse community, the most common sleep problem is chronic insomnia: three-in-four children and teens with ADHD, as well as 50 – 80% of ADHD-diagnosed adults, suffer from the condition.
Sleep and neurodivergency have a bidirectional relationship, just like anxiety and sleep or mental health conditions and sleep. Disrupted sleep also leads to worsened emotional regulation and fuels day-to-day ADHD impairment. In addition, neurodivergent people can struggle with establishing the routine and habits that support a good sleep.
The way neurodivergent people sleep is also different. They may often experience less restorative sleep than the neurotypical population. Most neurotypical people spend about 23% of their sleep in REM (rapid eye movement) – critical for learning and retaining memories – while most neurodiverse people spend around 15% of their nightly rest in that stage[1].
But crucially, sleep is a modifiable behaviour and there are positive steps the neurodivergent community can take to get back better sleep. Restoring balance can help to improve some of the challenges the community faces: improved sensory experiences, social communication, and the ability to tolerate change for people on the Autism spectrum, can all be influenced by effective sleep.
BEDTIME CHALLENGES
This is by no means an exhaustive list but goes to show some of the challenges commonly seen in the clinic. They are often habitual and may require intervention, but being aware of them is the first step in finding a solution:
Revenge bedtime procrastination: This is the tendency to procrastinate bedtime as a form of “revenge” from days filled with demands, sensory overload, and task-switching.
Freedom vs recovery: Time and space is needed to be ourselves, but also to relax and decompress from sensory overwhelm and demands. The only problem is that trying to fit both in comes at the cost of sleep.
Hyperfocus and hyperfixation: Daily schedules and uncontrolled social elements may well mean having to wait until the day before focusing on a project of interest. Because of neurodivergent people’s interest-based nervous systems, they often become hyper-focused and hyper-fixated. They lose track of time, and it is physically painful to stop for sleep.
Food, drink and medication timings: Because they do not register hunger and thirst signals in the same way as neurotypical people, many ADHD sufferers and people on the Autism spectrum struggle with the advice not to eat three hours before bedtime. Some may also not eat throughout the day and then have a ‘revenge’ meal late, so the body is working hard to digest a large meal rather than preparing for sleep. This is also the case with medication and wanting to exercise or socialise late, then eating and drinking afterwards.
WHAT NEXT?
Neurodivergence often impacts sleep wellness, and in turn this amplifies anxiety. Caring for your sleep can have a profoundly positive effect on the health of your mind and body and acknowledging issues is the first step in winning back good sleep. By identifying triggers, but also being gentle with themselves, neurodivergent people can make headway in getting a good night’s sleep.
However, it’s also important to recognise that sleep wellness won’t be perfect and that’s more than okay. It may also take longer for neurodivergent people to reset their sleep – around two to five weeks is not uncommon – and personalised routines that work for the individual are a useful tool in establishing better patterns for getting a good sleep.